Job Title: Medical Management Specialist I
Location: Downers Grove, IL
Duration: 6+ Months (possibility extension)
Shift/Schedule: Mon – Fri – 8AM – 5PM
Pay rate: $40-41/hr. on w2
Description:
- This position is responsible for conducting medical management and health education programs for customers on government health care programs.
- This role will include gathering, analyzing and providing date for regulatory reports.
- This position will represent the company to members.
JOB PURPOSE:
- This position is responsible for conducting medical management and health education programs for customers on government health care programs.
- Accountabilities include gathering, analyzing and providing date for regulatory reports. This position will represent the company to members.
JOB QUALIFICATIONS:
- Registered Nurse (RN), with 3 years direct clinical care to the consumer in a clinical setting or Licensed Professional Counselor (LPC), or Licensed Master Social Worker (LMSW), which includes 2 years of clinical practice to obtain their LPC or LMSW license. Current, valid, unrestricted license in the state of operations (or reciprocity).
- For compact licensee changing permanent residence to state of operations, you must obtain active, unrestricted RN licensure in the state of operations within 90 days of hire. Plus 3 years wellness or managed care experience presenting clinical issues with members/physicians.
- Knowledge of the health and wellness marketplace and employer trends.
- Verbal and written communication skills including discussing medical needs with members and interfacing with internal staff/management and external vendors and community resources.
- Analytical experience including medical data analysis.
- Current driver's license, transportation and applicable insurance.
- Ability and willingness to travel within assigned territory.
- PC proficiency to include Word, Excel, and PowerPoint, database experience and Web based applications.
PREFERRED JOB QUALIFICATIONS:
- 3 years clinical experience.
- Patient education experience.
- Condition Management experience.
- Transition of Care experience.
- Experience in managing complex or catastrophic cases.
- Certification in Case Management, Training, Project Management or nationally recognized health care certification.